NHS Scotland redesign of urgent care - first national staging review report: 1 December 2020 – 31 March 2021

Annex I: Primary Care OOH Services Overview

Primary Care OOH services are covered by a relatively small number of GPs and other multidisciplinary team members. The number of participating GPs has decreased over the years due to a variety of factors, including terms & conditions issues, pension pressures and increased requirements for day-time workforce capacity. The advent of COVID-19 hubs and CACs have placed further demands on redeployed GPs and primary care staff. It was envisaged and requested by SG that Flow Navigation Centre (FNC) staffing should draw both on primary and secondary care clinicians and support staff. In reality, the significant majority of RUC FNC medical staff to date have been GPs, as has been the case for COV-19 hubs and CACs. Many of these GPs have been previously working for Primary Care OOH services, risking serious destabilisation of the latter. As witnessed in pre-COVID-19 times, even a small reduction in GPs working regularly in OOH services can have disproportionately negative consequences, as recognised in the National Review of Primary Care Out-of-Hours Service in 2015. That Review advocated resolute action to rapidly develop and swell a GP-led, multidisciplinary team approach to OOH urgent care service delivery. This presaged a similar approach to the future development of in-hours GP services, as determined by the revised GMS Contract in 2018.

A small reduction in the number of GPs prepared to work for GP OOH services will have a disproportionate and significant impact on the ability of services to deliver care. As rotas become increasingly pressured, this may lead to rota shifts becoming more challenging and currently participating GPs may opt to do other (urgent care) work instead. Changing patterns of NHS 24 and RUC referrals with injury/trauma to OOH services, previously routed to or self-presenting to EDs may also pose difficulties for OOH services, including patient transport constraints. This underpins the earlier discussion above - that impacts on service and performance (in this case OOH services), cannot be fully ascertained on the basis of numerical attendances and episodes of care alone.